Biomarkers to Monitor Gluten-Free Diet Compliance in Celiac Patients

Nutrients. 2017 Jan 6;9(1):46. doi: 10.3390/nu9010046.


Gluten-free diet (GFD) is the only treatment for celiac disease (CD). There is a general consensus that strict GFD adherence in CD patients leads to full clinical and histological remission accompanied by improvement in quality of life and reduced long-term complications. Despite the importance of monitoring the GFD, there are no clear guidelines for assessing the outcome or for exploring its adherence. Available methods are insufficiently accurate to identify occasional gluten exposure that may cause intestinal mucosal damage. Serological tests are highly sensitive and specific for diagnosis, but do not predict recovery and are not useful for follow-up. The use of serial endoscopies, it is invasive and impractical for frequent monitoring, and dietary interview can be subjective. Therefore, the detection of gluten immunogenic peptides (GIP) in feces and urine have been proposed as new non-invasive biomarkers to detect gluten intake and verify GFD compliance in CD patients. These simple immunoassays in human samples could overcome some key unresolved scientific and clinical problems in CD management. It is a significant advance that opens up new possibilities for the clinicians to evaluate the CD treatment, GFD compliance, and improvement in the quality of life of CD patients.

Keywords: celiac disease; feces; gluten immunogenic peptides; gluten-free diet; urine.

Publication types

  • Review

MeSH terms

  • Biomarkers / urine*
  • Biopsy
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Databases, Factual
  • Diet, Gluten-Free*
  • Feces / chemistry
  • Humans
  • Intestinal Mucosa / physiopathology
  • Monitoring, Physiologic
  • Patient Compliance*
  • Quality of Life
  • Reproducibility of Results


  • Biomarkers